When Altruism Becomes Coercion

Medicine asks a great deal of the people who practice it, and much of what it asks is asked in the language of virtue. Clinicians are expected to stay late, absorb shortfalls, and carry the difference between what an institution provides and what a patient needs. Understood one way, this is professionalism. Understood another way, it is a budget line.

This paper examines the point at which an institution stops relying on altruism as a moral good practiced by individuals and begins depending on it as a structural input — something planned for, forecast, and quietly required. The distinction matters because the vocabulary does not change when the underlying relationship does.

Sections in development: the moral structure of professional obligation; institutional dependence and the economics of goodwill; consent, coercion, and the asymmetry of exit; what a non-exploitative account of professional virtue would require.